Norepinephrine versus dopamine pretreatment of potential heart donors - impact on long-term outcome

Background: Current guidelines advocate administration of inotropic agents to stabilize potential deceased heart-beating donors. A consensus on the specific agent or combination therapy is lacking. We thus initiated a retrospective analysis of patients being transplanted at our center in a matched-pair study design focusing on survival after donor pre-treatment either with norepinephrine or dopamine. Material/Methods: 936 patients (759 male; 177 female; mean age: 47.5 +/- 15.4 years) were transplanted at our center between 8/1981 and 12/2010. An overall of 22 patient pairs (all male; mean age 55.4 +/- 7.5 years; range 23-67 years) were matched according to our strict criteria. During follow-up (5037 +/- 1791 days) 11 deaths occurred. Overall survival in both groups was not different (p=0.1438). Results: In a sub-population analysis of all patient-pairs that completed 5-year follow-up (n= 19), Kaplan-Meier analysis revealed significant superior survival of recipients that received hearts pre-treated with norepinephrine vs. dopamine pre-treatment (p= 0.0368). Conclusions: Neither norepinephrine nor dopamine pre-treatment of potential heart donors showed superior overall survival. In a sub-population of long-term survivors norepinephrine pre-treatment was associated with better survival in a rather small cohort of heart transplant recipients. These findings underscore the urgent need of further prospective multicenter randomized trials to recommend a preferable adrenergic therapy. copy is for personal use only -distribution prohibited. This copy is for personal use only -distribution prohibited. This copy is for personal use only -distribution prohibited. This copy is for personal use only -distribution prohibited. This copy is for personal use only -distribution